A 54-Year-Old Man Comes to the Office After a Year

question 515

Multiple Choice

A 54-year-old man comes to the office after a year of progressive fatigue and frequent loose stools.  He describes voluminous, foul-smelling stools that float and are difficult to flush.  The patient has lost about 9 kg (20 lbs) in the past 6 months.  He was hospitalized on multiple occasions several years ago for epigastric pain radiating to the back, nausea, and vomiting.  Lately, the patient has had intermittent episodes of similar pain lasting for 15-30 minutes after meals.  He has had no hematemesis, hematochezia, or melena.  The patient stopped drinking alcohol several years ago and does not use tobacco or recreational drugs.  Temperature is 37 C (98.6 F) , blood pressure is 118/80 mm Hg, and pulse is 78/min.  BMI is 19.5 kg/m².  Abdominal examination shows epigastric tenderness on deep palpation.  Bowel sounds are normal.  Which of the following is most likely to improve this patient's symptoms?

• A)Antimicrobial therapy
• B)Cholecystectomy and stone removal
• C)Gluten-free diet
• D)Helicobacter pylori eradication
• E)Mesenteric angioplasty
• F)Pancreatic enzyme supplementation
• G)Restriction of dairy products

---

Definitions:

LEO

An acronym for Low Earth Orbit, which refers to a satellite orbit less than 2,000 kilometers above the Earth's surface, commonly used for telecommunications, military reconnaissance, and scientific observation.

MEO

Medium Earth Orbit, a region of space around the Earth above low Earth orbit and below geostationary orbit, typically used for satellites, including communication satellites.

VEO

Violent Extremist Organizations, groups that use or advocate for violence to achieve political, religious, or ideological objectives.

Project Loon

An initiative by Google to provide internet access to remote areas through a network of high-altitude balloons.